Chapter 1310: 1310
If audio player doesn't work, press Stop then Play button again
"Zhang Yuan has finally made a ward round!"
"The boss is going to make rounds!"
"The director of gastroenterology is going to pee his pants these days. Finally, boss Zhang is going to make a ward round!"
When Zhang Fan wanted to make a ward round, the female doctors of internal medicine were as frightened as if they were holding melon seeds one by one!
However, Zhang Fan's rare day-to-day visit in a medical department this week also made others feel something. This time, not only the leaders at home, but also the pill experts in intestinal surgery applied to participate in the ward round.
"I finally remember the internal medicine. No matter how to manage the internal medicine, the tea vegetable hospital will be the tea vegetable surgery hospital in the future.
Do you think this flower is sick? Why did it lie down? Not enough water? Or lack of fertilizer? " Ouyang looked at the cactus in front of him. It was straight yesterday, but how could it be crooked today?
She has nothing to do these days. She waters the flowers when she is bored.
"Ouyuan, are you going?" Lao Chen pretended not to hear Ouyang.
"I won't go. My feet are off the ground all day! " Ouyang said proudly. The old lady is very happy these days.
Because mitima GlaxoSmithKline has established a factory in tea, the tea government is not confident enough to tell the truth to such giants. Not only want to let the other party pay more, but also fear that others will dislike the ugly growth of tea.
Therefore, in order to make everyone more harmonious, Ouyang was invited by the tea government to communicate with Ms. Zeng of sanshima GlaxoSmithKline.
The tea government and Ms. Zeng of GlaxoSmithKline actually want Zhang Fan to be the middleman, but Zhang Fan recently opened a medical department and ignored them. As a last resort, Ouyang was invited.
Ouyang likes this kind of person, the great project of his predecessors and later.
On Monday morning, the weather is good. It rains more at night than during the day. Because of the snow mountains, the temperature is too high during the day, and there is often a light rain or moderate rain at night. The next morning, the air is filled with oxygen ions.
Moreover, the opening of all kinds of flowers in summer makes the tea air fragrant. In the frontier, in the northwest, where almost half of the territory is Gobi, such a city is really very different.
Of course, today at the tea vegetable hospital, I don't know how other doctors are feeling. Doctors in the Department of Gastroenterology are very nervous up and down.
"Are there any patients with bubble disease, those with excessive drugs, and those who stay in bed? Why are you still writing medical records? God, the Dean has hit the door. Do you still want to do it?" The director of Gastroenterology was so worried that his hair would jump up and stand up.
An hour before work in the Department, the staff not only arrived in place, but also made chickens fly and dogs jump. One is in a hurry.
The head nurse took the nurses to check the ward again and again, "clean up the excess things. The ward should be clean. Whose electric rice cooker should be taken away immediately. Don't come to the hospital next time you see it.
Old man, what are you doing? Hurry up and change your blanket into a hospital quilt. "
When it's time to go to work, I hear footsteps in the corridor, and there are many people. The director of Gastroenterology was sweating in the doctor's office“ Are you here? " He asked in a low voice.
"Here we are! It's all here! " The nurse stood at the door, took a sneak look and said immediately.
Zhang Fan has come to the ward round!
The leadership of the hospital, except Ouyang, who did great things, didn't come, all the other leaders came.
The middle-level leader, Lao Ju, came with a group of section directors.
The laboratory, the doctor and master who have something to do with digestion, also came.
It can be said that this ward round is estimated to be the largest and most complete talent team in the history of tea.
When Zhang Fan came to the internal medicine building in the morning, he saw a group of people waiting in the hall on the first floor of the internal medicine building. He directly saw a team of no less than 30 people waiting.
"Everyone is not busy today!"
Zhang Fan glanced at Xiao Chen.
"It's been a long time since the ward round. This time, Zhang Yuan spoke. Everyone is very enthusiastic. We can't decouple from business learning!" Lao Chen answered quickly.
"Hehe, why do you think of the big ward round of gastroenterology?" Yan Xiaoyu asked.
She was worried that Zhang Fan was not satisfied with the internal medicine, but she didn't say it. It was most frightening to lead without hair.
"The internal medicine department hasn't come to the ward round for a long time. I'm not busy these days! Since everyone is not busy, let's go to the ward round. Today we should be ready to be hungry. " Zhang Fan said with a smile. I stepped into the elevator first.
All eight elevators were on standby, and Zhang Fan's smiling face couldn't laugh“ It's not an example. It's not like the sick man to climb the stairs! "
Although Xiao Chen is not the leadership, she wants to follow the leaders, so after several leaders entered the first elevator, Zhang Fan said to Xiao Chen.
Xiao Chen stuck out his tongue and quickly agreed.
About thirty people entered the internal medicine office.
The director of Gastroenterology looked at Zhang Fan, meaning that the leader spoke!
Zhang Fan waved his hand to him to continue.
"Today's ward round starts from one bed. Please turn off the phone and be responsible for preparing all kinds of cases and materials of patients in their own beds in advance. Now start the ward round."
With that, the director of internal medicine hurried to Zhang Fan and let Zhang Fan go first.
That's the rule.
In any department, when making ward rounds, the discipline leader must be at the front, followed by three levels. Hula, the 30 people brought by the leaders, the original doctors in the Department and the doctors for internship and specialized training are almost 30 people, and then the nurses are more than 30, almost 100 people younger.
"Three beds, female, 45 years old. He had a history of liver cirrhosis for more than ten years. This time he was admitted to the hospital because of hematemesis and black feces combined with shock ascites. After admission, he was given active treatment to correct shock, improve hemoglobin and control bleeding... "
In the first room, I met a seriously ill patient.
After the bed doctor carefully reported his condition, he looked at all the ward rounds.
This time is generally divided into three kinds. Non professional leaders will nod their heads, look at the patient from a distance, and then ask, "the window should be closed on time, pay attention to ventilation and warmth, and don't let the patient catch a cold!"
Then holding the patient's hand, the reporter of the hospital newspaper took photos at the first time, and then the ward round ended. The doctors didn't take him at all.
The second is professional leadership, but not professional leadership. During ward rounds, I don't ask much questions, but I will read the doctor's orders. Occasionally, I will let the patient lie down and check the individual. After physical examination and medical advice, they hardly ask questions. Chinese leaders are very good at hiding their clumsiness.
The last one is the leader of this major. Doctors and nurses are worried about this kind of leadership ward round.
After the bed doctor reported, Zhang Fan didn't look at the medical record and directly started the physical examination, "ha ha, I'm the president of tea vegetable hospital. I'll do a physical examination for you today. Lie down."
Zhang Fan said with a smile to the middle-aged woman in front of him, and then lifted the patient's coat.
The patients are a little shivering. They are not in good health. Looking at the tube bed doctor who raises his head higher than the big cock on weekdays, she will be like a quail. She is also nervous. She doesn't know what's going on. What's going on.
"It's all right. They are all experts. You're lucky this time. So many people consult you. It's usually difficult to find all these experts." Lao Chen saw that the patient was a little nervous, so he smiled and explained slowly.
"Oh!"
The patients in other beds heard that they were experts or the dean. They hurriedly lay on the bed, opened their clothes and exposed their belly, waiting for the experts to touch them.
……
"The liver is palpable under the ribs and hard..." Zhang Fan reported his own data while checking. Doctors in the Department of Gastroenterology took out their notebooks to record, regardless of the tube and bed. Anyway, I don't know what to write, but the posture is put out.
"Is there a primary prevention education for patients before bleeding?"
"Yes, Zhang Yuan."
"After bleeding, did you give the patient a cerclage?"
"It's been nearly a year now."
"What is the bleeding rate after one year?"
"Yes..." the bed doctor couldn't answer!
“60%！” The superior doctor of the bed doctor quickly stood up and answered.
Zhang Fan didn't say anything, but the doctor in charge of the bed was flushed.
"Has renal function been tested regularly?"
"It has been checked regularly!"
Zhang Fan asked in great detail.
In detail, Ren Li and Yan Xiaoyu looked at each other“ I'm afraid it's a high level. Doesn't it mean that Zhang Yuan's internal medicine is just a reluctance? "
Yan Xiaoyu was shocked. Is this really the legendary pig eating tiger? So young, my God, with such a heavy mind, Yan Xiaoyu thought and quickly recalled whether he had made any mistakes in business after he came to the tea vegetable hospital.
"Why not add isosorbide mononitrate?" Zhang Fan has taken the medical record and started to give medical orders.
The doctor in charge of the bed was stunned. Yes, why isosorbide mononitrate?
The superior doctor was also stunned.
Internal medicine, how to say, is like a lottery. Before the lottery, everyone was covered with clouds, but once the lottery was opened, everyone suddenly realized that it was so.
It seems that everyone can understand. In fact, this is to start taking drugs according to the symptoms, signs and the development of the disease.
It's well written in the teaching book. This medicine is used for this disease. It seems irresponsible at all. To tell the truth, if it's really so simple, just pull out two high school students and let them familiarize themselves with internal medicine books, they can also give people medical treatment and medicine.
"Oh? Didn't you think? Octreotide is solid! " Zhang Fan clapped the case in his hand.
"Come on, director Li, why don't you use isosorbide mononitrate!" Zhang Fan said to the director of Gastroenterology with a smile.
Today, if the director doesn't know why isosorbide mononitrate is added or not, Zhang Fan is determined to take him.
The sweating director didn't know Zhang Fan's target at this time. Did he come to catch octreotide, an expensive drug, or the quality of cases!
"Although the patient has been cerclaged for nearly a year, the bleeding is not obvious at present, and the patient's liver function is poor. In order to protect the liver, we did not consider using isosorbide mononitrate!"
Zhang Fan listened and looked at the director of Gastroenterology. "The level is there, but the heart is not here!"
The level of director of gastroenterology department still exists.
"When do you think it's appropriate to add it. It's 60% possible to relapse, and she's bleeding again now. You can't spit blood and give octreotide to stop the blood. It doesn't matter. My senior director, will you use dessert? "
Zhang Fan handed the medical record to the director of the digestive department, but did not let go. Lao Li, the director of the digestive department, looked ashamed.
The time is just dozens of seconds, as if it had been a long time.
The ward rounds, especially the surgical leaders, looked at Zhang Fan with panic in their eyes.
"Zhang Yuan is going to do internal medicine?"
Zhang Fan ignored them. After releasing the case, he said, "continue rounds."
Turn around and continue.
Everyone looks at Zhang Fan.
Like the popular saying, I'm standing here. You see, I'm kind of like that year!
While making rounds, Zhang Fan compared them in the system of his mind. Internal medicine is actually more complicated than surgery.
In the short term, some treatments are good to the left and right, but in the long term, they are different,
Maybe there are too few long-term doctors.
So Zhang Fan took the treatment plan into the system and compared it one by one.
Please report us if you find any errors so we can fix it asap!
"Zhang Yuan has finally made a ward round!"
"The boss is going to make rounds!"
"The director of gastroenterology is going to pee his pants these days. Finally, boss Zhang is going to make a ward round!"
When Zhang Fan wanted to make a ward round, the female doctors of internal medicine were as frightened as if they were holding melon seeds one by one!
However, Zhang Fan's rare day-to-day visit in a medical department this week also made others feel something. This time, not only the leaders at home, but also the pill experts in intestinal surgery applied to participate in the ward round.
"I finally remember the internal medicine. No matter how to manage the internal medicine, the tea vegetable hospital will be the tea vegetable surgery hospital in the future.
Do you think this flower is sick? Why did it lie down? Not enough water? Or lack of fertilizer? " Ouyang looked at the cactus in front of him. It was straight yesterday, but how could it be crooked today?
She has nothing to do these days. She waters the flowers when she is bored.
"Ouyuan, are you going?" Lao Chen pretended not to hear Ouyang.
"I won't go. My feet are off the ground all day! " Ouyang said proudly. The old lady is very happy these days.
Because mitima GlaxoSmithKline has established a factory in tea, the tea government is not confident enough to tell the truth to such giants. Not only want to let the other party pay more, but also fear that others will dislike the ugly growth of tea.
Therefore, in order to make everyone more harmonious, Ouyang was invited by the tea government to communicate with Ms. Zeng of sanshima GlaxoSmithKline.
The tea government and Ms. Zeng of GlaxoSmithKline actually want Zhang Fan to be the middleman, but Zhang Fan recently opened a medical department and ignored them. As a last resort, Ouyang was invited.
Ouyang likes this kind of person, the great project of his predecessors and later.
On Monday morning, the weather is good. It rains more at night than during the day. Because of the snow mountains, the temperature is too high during the day, and there is often a light rain or moderate rain at night. The next morning, the air is filled with oxygen ions.
Moreover, the opening of all kinds of flowers in summer makes the tea air fragrant. In the frontier, in the northwest, where almost half of the territory is Gobi, such a city is really very different.
Of course, today at the tea vegetable hospital, I don't know how other doctors are feeling. Doctors in the Department of Gastroenterology are very nervous up and down.
"Are there any patients with bubble disease, those with excessive drugs, and those who stay in bed? Why are you still writing medical records? God, the Dean has hit the door. Do you still want to do it?" The director of Gastroenterology was so worried that his hair would jump up and stand up.
An hour before work in the Department, the staff not only arrived in place, but also made chickens fly and dogs jump. One is in a hurry.
The head nurse took the nurses to check the ward again and again, "clean up the excess things. The ward should be clean. Whose electric rice cooker should be taken away immediately. Don't come to the hospital next time you see it.
Old man, what are you doing? Hurry up and change your blanket into a hospital quilt. "
When it's time to go to work, I hear footsteps in the corridor, and there are many people. The director of Gastroenterology was sweating in the doctor's office“ Are you here? " He asked in a low voice.
"Here we are! It's all here! " The nurse stood at the door, took a sneak look and said immediately.
Zhang Fan has come to the ward round!
The leadership of the hospital, except Ouyang, who did great things, didn't come, all the other leaders came.
The middle-level leader, Lao Ju, came with a group of section directors.
The laboratory, the doctor and master who have something to do with digestion, also came.
It can be said that this ward round is estimated to be the largest and most complete talent team in the history of tea.
When Zhang Fan came to the internal medicine building in the morning, he saw a group of people waiting in the hall on the first floor of the internal medicine building. He directly saw a team of no less than 30 people waiting.
"Everyone is not busy today!"
Zhang Fan glanced at Xiao Chen.
"It's been a long time since the ward round. This time, Zhang Yuan spoke. Everyone is very enthusiastic. We can't decouple from business learning!" Lao Chen answered quickly.
"Hehe, why do you think of the big ward round of gastroenterology?" Yan Xiaoyu asked.
She was worried that Zhang Fan was not satisfied with the internal medicine, but she didn't say it. It was most frightening to lead without hair.
"The internal medicine department hasn't come to the ward round for a long time. I'm not busy these days! Since everyone is not busy, let's go to the ward round. Today we should be ready to be hungry. " Zhang Fan said with a smile. I stepped into the elevator first.
All eight elevators were on standby, and Zhang Fan's smiling face couldn't laugh“ It's not an example. It's not like the sick man to climb the stairs! "
Although Xiao Chen is not the leadership, she wants to follow the leaders, so after several leaders entered the first elevator, Zhang Fan said to Xiao Chen.
Xiao Chen stuck out his tongue and quickly agreed.
About thirty people entered the internal medicine office.
The director of Gastroenterology looked at Zhang Fan, meaning that the leader spoke!
Zhang Fan waved his hand to him to continue.
"Today's ward round starts from one bed. Please turn off the phone and be responsible for preparing all kinds of cases and materials of patients in their own beds in advance. Now start the ward round."
With that, the director of internal medicine hurried to Zhang Fan and let Zhang Fan go first.
That's the rule.
In any department, when making ward rounds, the discipline leader must be at the front, followed by three levels. Hula, the 30 people brought by the leaders, the original doctors in the Department and the doctors for internship and specialized training are almost 30 people, and then the nurses are more than 30, almost 100 people younger.
"Three beds, female, 45 years old. He had a history of liver cirrhosis for more than ten years. This time he was admitted to the hospital because of hematemesis and black feces combined with shock ascites. After admission, he was given active treatment to correct shock, improve hemoglobin and control bleeding... "
In the first room, I met a seriously ill patient.
After the bed doctor carefully reported his condition, he looked at all the ward rounds.
This time is generally divided into three kinds. Non professional leaders will nod their heads, look at the patient from a distance, and then ask, "the window should be closed on time, pay attention to ventilation and warmth, and don't let the patient catch a cold!"
Then holding the patient's hand, the reporter of the hospital newspaper took photos at the first time, and then the ward round ended. The doctors didn't take him at all.
The second is professional leadership, but not professional leadership. During ward rounds, I don't ask much questions, but I will read the doctor's orders. Occasionally, I will let the patient lie down and check the individual. After physical examination and medical advice, they hardly ask questions. Chinese leaders are very good at hiding their clumsiness.
The last one is the leader of this major. Doctors and nurses are worried about this kind of leadership ward round.
After the bed doctor reported, Zhang Fan didn't look at the medical record and directly started the physical examination, "ha ha, I'm the president of tea vegetable hospital. I'll do a physical examination for you today. Lie down."
Zhang Fan said with a smile to the middle-aged woman in front of him, and then lifted the patient's coat.
The patients are a little shivering. They are not in good health. Looking at the tube bed doctor who raises his head higher than the big cock on weekdays, she will be like a quail. She is also nervous. She doesn't know what's going on. What's going on.
"It's all right. They are all experts. You're lucky this time. So many people consult you. It's usually difficult to find all these experts." Lao Chen saw that the patient was a little nervous, so he smiled and explained slowly.
"Oh!"
The patients in other beds heard that they were experts or the dean. They hurriedly lay on the bed, opened their clothes and exposed their belly, waiting for the experts to touch them.
……
"The liver is palpable under the ribs and hard..." Zhang Fan reported his own data while checking. Doctors in the Department of Gastroenterology took out their notebooks to record, regardless of the tube and bed. Anyway, I don't know what to write, but the posture is put out.
"Is there a primary prevention education for patients before bleeding?"
"Yes, Zhang Yuan."
"After bleeding, did you give the patient a cerclage?"
"It's been nearly a year now."
"What is the bleeding rate after one year?"
"Yes..." the bed doctor couldn't answer!
“60%！” The superior doctor of the bed doctor quickly stood up and answered.
Zhang Fan didn't say anything, but the doctor in charge of the bed was flushed.
"Has renal function been tested regularly?"
"It has been checked regularly!"
Zhang Fan asked in great detail.
In detail, Ren Li and Yan Xiaoyu looked at each other“ I'm afraid it's a high level. Doesn't it mean that Zhang Yuan's internal medicine is just a reluctance? "
Yan Xiaoyu was shocked. Is this really the legendary pig eating tiger? So young, my God, with such a heavy mind, Yan Xiaoyu thought and quickly recalled whether he had made any mistakes in business after he came to the tea vegetable hospital.
"Why not add isosorbide mononitrate?" Zhang Fan has taken the medical record and started to give medical orders.
The doctor in charge of the bed was stunned. Yes, why isosorbide mononitrate?
The superior doctor was also stunned.
Internal medicine, how to say, is like a lottery. Before the lottery, everyone was covered with clouds, but once the lottery was opened, everyone suddenly realized that it was so.
It seems that everyone can understand. In fact, this is to start taking drugs according to the symptoms, signs and the development of the disease.
It's well written in the teaching book. This medicine is used for this disease. It seems irresponsible at all. To tell the truth, if it's really so simple, just pull out two high school students and let them familiarize themselves with internal medicine books, they can also give people medical treatment and medicine.
"Oh? Didn't you think? Octreotide is solid! " Zhang Fan clapped the case in his hand.
"Come on, director Li, why don't you use isosorbide mononitrate!" Zhang Fan said to the director of Gastroenterology with a smile.
Today, if the director doesn't know why isosorbide mononitrate is added or not, Zhang Fan is determined to take him.
The sweating director didn't know Zhang Fan's target at this time. Did he come to catch octreotide, an expensive drug, or the quality of cases!
"Although the patient has been cerclaged for nearly a year, the bleeding is not obvious at present, and the patient's liver function is poor. In order to protect the liver, we did not consider using isosorbide mononitrate!"
Zhang Fan listened and looked at the director of Gastroenterology. "The level is there, but the heart is not here!"
The level of director of gastroenterology department still exists.
"When do you think it's appropriate to add it. It's 60% possible to relapse, and she's bleeding again now. You can't spit blood and give octreotide to stop the blood. It doesn't matter. My senior director, will you use dessert? "
Zhang Fan handed the medical record to the director of the digestive department, but did not let go. Lao Li, the director of the digestive department, looked ashamed.
The time is just dozens of seconds, as if it had been a long time.
The ward rounds, especially the surgical leaders, looked at Zhang Fan with panic in their eyes.
"Zhang Yuan is going to do internal medicine?"
Zhang Fan ignored them. After releasing the case, he said, "continue rounds."
Turn around and continue.
Everyone looks at Zhang Fan.
Like the popular saying, I'm standing here. You see, I'm kind of like that year!
While making rounds, Zhang Fan compared them in the system of his mind. Internal medicine is actually more complicated than surgery.
In the short term, some treatments are good to the left and right, but in the long term, they are different,
Maybe there are too few long-term doctors.
So Zhang Fan took the treatment plan into the system and compared it one by one.
"Zhang Yuan has finally made a ward round!""The boss is going to make rounds!""The director of gastroenterology is going to pee his pants these days. Finally, boss Zhang is going to make a ward round!"When Zhang Fan wanted to make a ward round, the female doctors of internal medicine were as frightened as if they were holding melon seeds one by one!However, Zhang Fan's rare day-to-day visit in a medical department this week also made others feel something. This time, not only the leaders at home, but also the pill experts in intestinal surgery applied to participate in the ward round."I finally remember the internal medicine. No matter how to manage the internal medicine, the tea vegetable hospital will be the tea vegetable surgery hospital in the future.Do you think this flower is sick? Why did it lie down? Not enough water? Or lack of fertilizer? " Ouyang looked at the cactus in front of him. It was straight yesterday, but how could it be crooked today?She has nothing to do these days. She waters the flowers when she is bored."Ouyuan, are you going?" Lao Chen pretended not to hear Ouyang."I won't go. My feet are off the ground all day! " Ouyang said proudly. The old lady is very happy these days.Because mitima GlaxoSmithKline has established a factory in tea, the tea government is not confident enough to tell the truth to such giants. Not only want to let the other party pay more, but also fear that others will dislike the ugly growth of tea.Therefore, in order to make everyone more harmonious, Ouyang was invited by the tea government to communicate with Ms. Zeng of sanshima GlaxoSmithKline.The tea government and Ms. Zeng of GlaxoSmithKline actually want Zhang Fan to be the middleman, but Zhang Fan recently opened a medical department and ignored them. As a last resort, Ouyang was invited.Ouyang likes this kind of person, the great project of his predecessors and later.On Monday morning, the weather is good. It rains more at night than during the day. Because of the snow mountains, the temperature is too high during the day, and there is often a light rain or moderate rain at night. The next morning, the air is filled with oxygen ions.Moreover, the opening of all kinds of flowers in summer makes the tea air fragrant. In the frontier, in the northwest, where almost half of the territory is Gobi, such a city is really very different.Of course, today at the tea vegetable hospital, I don't know how other doctors are feeling. Doctors in the Department of Gastroenterology are very nervous up and down."Are there any patients with bubble disease, those with excessive drugs, and those who stay in bed? Why are you still writing medical records? God, the Dean has hit the door. Do you still want to do it?" The director of Gastroenterology was so worried that his hair would jump up and stand up.An hour before work in the Department, the staff not only arrived in place, but also made chickens fly and dogs jump. One is in a hurry.The head nurse took the nurses to check the ward again and again, "clean up the excess things. The ward should be clean. Whose electric rice cooker should be taken away immediately. Don't come to the hospital next time you see it.Old man, what are you doing? Hurry up and change your blanket into a hospital quilt. "When it's time to go to work, I hear footsteps in the corridor, and there are many people. The director of Gastroenterology was sweating in the doctor's office Are you here? " He asked in a low voice."Here we are! It's all here! " The nurse stood at the door, took a sneak look and said immediately.Zhang Fan has come to the ward round!The leadership of the hospital, except Ouyang, who did great things, didn't come, all the other leaders came.The middle-level leader, Lao Ju, came with a group of section directors.The laboratory, the doctor and master who have something to do with digestion, also came.It can be said that this ward round is estimated to be the largest and most complete talent team in the history of tea.When Zhang Fan came to the internal medicine building in the morning, he saw a group of people waiting in the hall on the first floor of the internal medicine building. He directly saw a team of no less than 30 people waiting."Everyone is not busy today!"Zhang Fan glanced at Xiao Chen."It's been a long time since the ward round. This time, Zhang Yuan spoke. Everyone is very enthusiastic. We can't decouple from business learning!" Lao Chen answered quickly."Hehe, why do you think of the big ward round of gastroenterology?" Yan Xiaoyu asked.She was worried that Zhang Fan was not satisfied with the internal medicine, but she didn't say it. It was most frightening to lead without hair."The internal medicine department hasn't come to the ward round for a long time. I'm not busy these days! Since everyone is not busy, let's go to the ward round. Today we should be ready to be hungry. " Zhang Fan said with a smile. I stepped into the elevator first.All eight elevators were on standby, and Zhang Fan's smiling face couldn't laugh It's not an example. It's not like the sick man to climb the stairs! "Although Xiao Chen is not the leadership, she wants to follow the leaders, so after several leaders entered the first elevator, Zhang Fan said to Xiao Chen.Xiao Chen stuck out his tongue and quickly agreed.About thirty people entered the internal medicine office.The director of Gastroenterology looked at Zhang Fan, meaning that the leader spoke!Zhang Fan waved his hand to him to continue."Today's ward round starts from one bed. Please turn off the phone and be responsible for preparing all kinds of cases and materials of patients in their own beds in advance. Now start the ward round."With that, the director of internal medicine hurried to Zhang Fan and let Zhang Fan go first.That's the rule.In any department, when making ward rounds, the discipline leader must be at the front, followed by three levels. Hula, the 30 people brought by the leaders, the original doctors in the Department and the doctors for internship and specialized training are almost 30 people, and then the nurses are more than 30, almost 100 people younger."Three beds, female, 45 years old. He had a history of liver cirrhosis for more than ten years. This time he was admitted to the hospital because of hematemesis and black feces combined with shock ascites. After admission, he was given active treatment to correct shock, improve hemoglobin and control bleeding... "In the first room, I met a seriously ill patient.After the bed doctor carefully reported his condition, he looked at all the ward rounds.This time is generally divided into three kinds. Non professional leaders will nod their heads, look at the patient from a distance, and then ask, "the window should be closed on time, pay attention to ventilation and warmth, and don't let the patient catch a cold!"Then holding the patient's hand, the reporter of the hospital newspaper took photos at the first time, and then the ward round ended. The doctors didn't take him at all.The second is professional leadership, but not professional leadership. During ward rounds, I don't ask much questions, but I will read the doctor's orders. Occasionally, I will let the patient lie down and check the individual. After physical examination and medical advice, they hardly ask questions. Chinese leaders are very good at hiding their clumsiness.The last one is the leader of this major. Doctors and nurses are worried about this kind of leadership ward round.After the bed doctor reported, Zhang Fan didn't look at the medical record and directly started the physical examination, "ha ha, I'm the president of tea vegetable hospital. I'll do a physical examination for you today. Lie down."Zhang Fan said with a smile to the middle-aged woman in front of him, and then lifted the patient's coat.The patients are a little shivering. They are not in good health. Looking at the tube bed doctor who raises his head higher than the big cock on weekdays, she will be like a quail. She is also nervous. She doesn't know what's going on. What's going on."It's all right. They are all experts. You're lucky this time. So many people consult you. It's usually difficult to find all these experts." Lao Chen saw that the patient was a little nervous, so he smiled and explained slowly."Oh!"The patients in other beds heard that they were experts or the dean. They hurriedly lay on the bed, opened their clothes and exposed their belly, waiting for the experts to touch them."The liver is palpable under the ribs and hard..." Zhang Fan reported his own data while checking. Doctors in the Department of Gastroenterology took out their notebooks to record, regardless of the tube and bed. Anyway, I don't know what to write, but the posture is put out."Is there a primary prevention education for patients before bleeding?""Yes, Zhang Yuan.""After bleeding, did you give the patient a cerclage?""It's been nearly a year now.""What is the bleeding rate after one year?""Yes..." the bed doctor couldn't answer!60% The superior doctor of the bed doctor quickly stood up and answered.Zhang Fan didn't say anything, but the doctor in charge of the bed was flushed."Has renal function been tested regularly?""It has been checked regularly!"Zhang Fan asked in great detail.In detail, Ren Li and Yan Xiaoyu looked at each other I'm afraid it's a high level. Doesn't it mean that Zhang Yuan's internal medicine is just a reluctance? "Yan Xiaoyu was shocked. Is this really the legendary pig eating tiger? So young, my God, with such a heavy mind, Yan Xiaoyu thought and quickly recalled whether he had made any mistakes in business after he came to the tea vegetable hospital."Why not add isosorbide mononitrate?" Zhang Fan has taken the medical record and started to give medical orders.The doctor in charge of the bed was stunned. Yes, why isosorbide mononitrate?The superior doctor was also stunned.Internal medicine, how to say, is like a lottery. Before the lottery, everyone was covered with clouds, but once the lottery was opened, everyone suddenly realized that it was so.It seems that everyone can understand. In fact, this is to start taking drugs according to the symptoms, signs and the development of the disease.It's well written in the teaching book. This medicine is used for this disease. It seems irresponsible at all. To tell the truth, if it's really so simple, just pull out two high school students and let them familiarize themselves with internal medicine books, they can also give people medical treatment and medicine."Oh? Didn't you think? Octreotide is solid! " Zhang Fan clapped the case in his hand."Come on, director Li, why don't you use isosorbide mononitrate!" Zhang Fan said to the director of Gastroenterology with a smile.Today, if the director doesn't know why isosorbide mononitrate is added or not, Zhang Fan is determined to take him.The sweating director didn't know Zhang Fan's target at this time. Did he come to catch octreotide, an expensive drug, or the quality of cases!"Although the patient has been cerclaged for nearly a year, the bleeding is not obvious at present, and the patient's liver function is poor. In order to protect the liver, we did not consider using isosorbide mononitrate!"Zhang Fan listened and looked at the director of Gastroenterology. "The level is there, but the heart is not here!"The level of director of gastroenterology department still exists."When do you think it's appropriate to add it. It's 60% possible to relapse, and she's bleeding again now. You can't spit blood and give octreotide to stop the blood. It doesn't matter. My senior director, will you use dessert? "Zhang Fan handed the medical record to the director of the digestive department, but did not let go. Lao Li, the director of the digestive department, looked ashamed.The time is just dozens of seconds, as if it had been a long time.The ward rounds, especially the surgical leaders, looked at Zhang Fan with panic in their eyes."Zhang Yuan is going to do internal medicine?"Zhang Fan ignored them. After releasing the case, he said, "continue rounds."Turn around and continue.Everyone looks at Zhang Fan.Like the popular saying, I'm standing here. You see, I'm kind of like that year!While making rounds, Zhang Fan compared them in the system of his mind. Internal medicine is actually more complicated than surgery.In the short term, some treatments are good to the left and right, but in the long term, they are different,Maybe there are too few long-term doctors.So Zhang Fan took the treatment plan into the system and compared it one by one.
